Professor Diane M. Harper contributes to cervical cancer screening and HPV vaccination research projects

January is Cervical Cancer Awareness Month. This gives the Department of Family Medicine the opportunity to spotlight Professor Diane M. Harper, MD, MPH, MS, the world’s top co-cited cervical cancer prevention researcher who is both an active clinical provider and scientist.   

Professor Diane M. Harper, MD, MPH, MS

Harper is also an internationally renowned expert in cervical cancer and HPV vaccines who was instrumental in bringing clinical HPV vaccine trials to the world 20 years ago. She actively contributes groundbreaking work in cervical cancer prevention and serves as a mentor for younger researchers in this field. 

Most recently she has mentored medical students, residents and fellows to accomplish a 10-year review of cervical cancer among Lakota Indians in South Dakota. Her second group of mentees was from Canada, working on understanding the socioeconomic determinants of HPV vaccine uptake among girls globally.  

The following is a summary of both papers, plus links to Harper’s other recent cervical cancer-related publications. 

Tracking cancer screenings and treatment among a vulnerable population 

In the paper, “Cervical Cancer 2010-2019: An Upper Midwest Catchment of 40,000 Square Miles,” Harper teamed with Native American gynecologic oncologist Keely K. Ulmer, MD, formerly of the University of Iowa and now practicing in Rapid City, S.D., and Daniel Peteriet, MD, the lead radiation oncologist from Monument Health Cancer Care Institute, also in Rapid City, on a 10-year study of cervical cancer presentation, diagnosis and mortality among American Indian (AI) and white women living around and within the Pine Ridge Reservation in South Dakota. 

Due to generational trauma and systemic oppression, Pine Ridge Reservation residents experience many barriers to care, including lower prevalence of cancer screening and vaccination; poor follow-up care; cancers that aren’t diagnosed in their earlier stages; or guideline-concordant care. Previous research also found AI women experience higher incidences of and mortality rates due to cervical cancer as compared to white women. 

Harper and her co-authors examined a detailed cancer registry maintained at the Western South Dakota Cancer Center, which is connected to the clinic records of all cervical cancer patients between 2010 and 2019. The registry provided 126 records of both AI women (25) and white women (98). Among all 126 individuals with cervical cancer, 60% had not participated in cervical cancer screening within the five years before their diagnosis and, on average, more than nine years had passed since their last cervical cancer screening. 

Among just the AI population, half did not participate in cervical cancer screening prior to their diagnosis. Of those women who screened positively for cervical cancer, five received no clinical workup. Among the 20 that received a workup, 17 had biopsies performed without a colposcopy and three with colposcopy, considered standard of care after an abnormal screen.  

The team states that their results continue to show the lack of improvement for cervical cancer prevention among Native American and AI women, as this level of cancer without screening has been present for many decades. The authors are the first to provide the timelines in diagnostic work ups, either from an abnormal screen or the identification of a major symptom. Their results also provide new data questioning the use of colposcopy for symptomatic women. Colposcopy is not part of the National Comprehensive Cancer Network guidelines for the workup of a person symptomatic of cervical cancer -- only asymptomatic individuals who require additional testing.  

Furthermore, the authors assert that symptomatic women must be evaluated for immediate diagnosis and recommend a blind biopsy for women presenting with cervical cancer symptoms.  

What factors promote HPV vaccination initiation and completion among girls? 

In the second study, Harper partnered with University of Manitoba researchers, as well as Caroline Richardson, MD, professor emerita of U-M's Department of Family Medicine, to appraise and summarize published evidence on individual socioeconomic and health-related factors associated with human papillomavirus (HPV) vaccination initiation and completion among pediatric-age girls.  

The paper is titled, “Socioeconomic/health-related factors associated with HPV vaccination initiation/completion among females of paediatric age: A systematic review with meta-analysis" and was published in the journal Public Health in Practice.  

HPV is the most common sexually transmitted disease globally, with 80 percent of sexually active individuals contracting HPV at some point in their lives. Many HPV infections go away on their own; however, HPV vaccinations have been an effective preventive measure against certain viral strains and is FDA approved for females 9-45 years old. 

Despite the availability of the HPV vaccine and publicly funded pediatric vaccination programs in many countries, initiation of the vaccine and the two-dose vaccination series completion rates remain low. 

The team conducted a literature search in 2022, which included 83 cross-sectional studies. They found the following factors strongly increased the odds of vaccination initiation: 

These factors very strongly increased the odds of vaccination initiation: 

The following factors strongly increased the odds of vaccination series completion: 

The authors noted that results derived from foreign countries were akin to those among American girls. They assert that these factors may be key to identifying girls at increased risk of not being vaccinated and could aid in creating targeted public health messaging. 

Articles cited:  

Ulmer, K. K., Wilson, P. L., Petereit, M. A., Sargent, M., Cina, K., Kroboth, L., Petereit, D. G., & Harper, D. M. (2024). Cervical cancer 2010–2019: An Upper Midwest catchment of 40,000 square miles. Journal of Lower Genital Tract Disease, 29(1), 23–30. https://doi.org/10.1097/lgt.0000000000000853 

Okoli, G. N., Grossman Moon, A., Soos, A. E., Neilson, C. J., Kimmel Supron, H., Etsell, K., Grewal, A., Van Caeseele, P., Richardson, C., & Harper, D. M. (2025). Socioeconomic/health-related factors associated with HPV vaccination initiation/completion among females of paediatric age: A systematic review with meta-analysis. Public Health in Practice, 9, 100562. https://doi.org/10.1016/j.puhip.2024.100562 

Other papers/abstracts which feature Dr. Harper’s recent contributions:

"Cervical cancer screening: Impact of collection technique on human papillomavirus detection and genotyping" in Preventive Medicine Reports. Read the paper here.   

"The secrets of an optimal vaginal microbiome" in Nature Portfolio. Read the paper here.  

"A Novel Multi-Strain Vaginal Synbiotic is Effective in Optimizing the Vaginal Microbiome: Results from a Randomized, Placebo-Controlled Clinical Trial.” Read the paper in the Journal of Obstetrics & Gynecology here.  

“Strategies to Optimize Cervical Cancer Screening Rates Among Transgender and Gender-Diverse People Assigned Female at Birth” in the Journal of General Internal Medicine. Read the paper here. 

Haro E, Butcher EA, Alves ML, El Khoury C, Vinson A, Harper DM. Barriers to Cervical Cancer Screening and Satisfaction with Self-Sampling among Black Women in Michigan: a Mixed Methods Study. Med Res Arch. 2024 Apr;12(4):doi: 10.18103/mra.v12i4.5209. Epub 2024 Apr 26.